Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1774 | NE |
NPI | 1295079838 |
---|---|
Provider Name | Dr. Joel Stuart Martenson |
First Address | Aurora, NE 68818-1259 |
Second Address | Aurora, NE 68818-1259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 04/01/2017 |